Medicaid Expansion in New Hampshire: The Need for Federalism

Editor’s Note: Breitbart News Network, American Principles Project, and Cornerstone Action are co-sponsors of an upcoming forum centered on the principles of federalism. More information about the forum can be found at Cornerstone, American Principles Project, and Breitbart News.

Medicaid expansion, an Obamacare feature, was dragged into New Hampshire by a bipartisan team of legislators, in spite of the GOP platform plank that said very clearly they “oppose the implementation of Obamacare in New Hampshire.”

What happened?

Likely what usually happens when a state adopts a federal program: free money. The problem, as always, is that free money from the feds isn’t really free. To make matters worse, New Hampshire’s adoption of the expansion offers health care coverage to residents without any guarantee that the program can be extended beyond 2016. This was supposed to placate expansion advocates as well as fiscal conservatives.

Yes, fiscal conservatism was allegedly involved: New Hampshire’s participation in the expansion is supposed to sunset in 2016 if federal money dries up.

Sunset an entitlement program in an election year? Not likely. This year’s free money from Washington is assured. When that largesse dries up, New Hampshire will be responsible for providing health care coverage for tens of thousands of residents beyond those who were already enrolled in Medicaid before expansion.

Existing revenue sources will be inadequate. A state sales and/or income tax raise will be all but assured. That’s what today’s “free money” from Washington means.

As recently as July, after the expansion vote but before the 2014 election, a Foundation for Government Accountability poll found that 74.5% of self-identified GOP voters in New Hampshire opposed Medicaid expansion. Nevertheless, those voters returned to office most of the Republican leaders who shepherded expansion through the state Senate.

Federalism isn’t yet a top-tier issue in the Granite State. It will be forced to the front pages in 2016 when the legislature has to take up the sunset provision of Medicaid expansion.

Expansion advocates had no trouble making a case for counterfeit compassion: promising medical care to economically vulnerable New Hampshire residents when funding for the program is precarious. They cast opponents as being uncaring toward low-income New Hampshire neighbors.

Leaders trying to fight that accusation need the confidence and determination to explain how promising medical care without being able to pay for it is not compassionate. It’s time for leaders who understand the dangers of Washington’s “free money.” Leaders need to understand that Medicaid itself is providing substandard care, compared to medical outcomes for people with other forms of insurance. (Americans for Prosperity – NH has taken the lead in warning legislators about that point.) Every New Hampshire resident will be touched by increased taxation when the Medicaid expansion bills start coming to Concord instead of Washington. New Hampshire problems need New Hampshire solutions, not “free money.”

Learning to make the case for federalism is not an academic option. It’s becoming a civic imperative. Cornerstone Policy Research is presenting a “Practical Federalism” forum on November 22 to meet that challenge. We invite you to Southern New Hampshire University for this event co-sponsored by Americans for Prosperity-NH, the American Principles Project, and Breitbart News. Register today.

Bryan McCormack is the executive director of Cornerstone Policy Research.